Medi-Cal RX 2021
**Medi-Cal Rx 2021 Update-Go-Live April 1, 2021
Medi-Cal Rx has lengthened the transition time for full implementation to April 1, 2021. Given the ongoing challenges with COVID-19 the Department of Health Care Services (DHCS) along with Magellan Medicaid Administration has decided to lengthen the time for the full implementation to Medi-Cal Rx by three (3) months. For more information click here
Effective April 1, 2021 Medi-Cal Pharmacy benefits will be transitioned from CenCal Health to Medi-Cal fee-for-service under the name of Medi-Cal Rx.
What is changing?
- All pharmacy benefits billed by a pharmacy on a pharmacy claim will be carved out of CenCal Health and will be the responsibility of the state and their pharmacy benefit administrator, Magellan
What will remain the same?
- All pharmacy benefits billed on a medical or institutional claim by a pharmacy or any provider (i.e. Physician-Administered-Drugs) will be the responsibility of CenCal Health
DHCS continues to make significant progress towards a successful transition of pharmacy services on April 1, 2021 to Medi-Cal Rx.
Below are references and resources to help the transition over to Medi-Cal Rx.
Medi-Cal Rx References and Resources:
Starting April 1, 2021, providers can call the Medi-Cal Rx Call Center at 800-977-2273 (TTY: Dial 7-1-1) and a representative from the Medi-Cal Rx team at Magellan will be able to assist 7 days a week, 24 hours a day.
Prepare for 2020-2021 Flu Season
The Flu Season is now upon us. The Pharmacy Flu Program can help your patients stay healthy this flu season. As part of the pharmacy benefits provided by CenCal Health and MedImpact, our members are eligible to receive the flu vaccine directly from a participating pharmacy in our network. CenCal Health members may choose from a variety of participating pharmacy locations including drug stores, supermarkets, retailers and independent pharmacies. Members may contact their local pharmacy for vaccination hours and appointment requirements. If providers choose to administer the flu vaccine in their office, they can bill CenCal Heath.
If you have questions regarding the Pharmacy Flu Program, please contact the CenCal Health Pharmacy Services Department at (800) 421-2560 ext. 1080
Synagis® Pharmacy Update: RSV Season
CenCal Health would like to assist our members and providers in preparation for the upcoming RSV season. In conjunction with the Department of Health Care Services’ Children’s Medical Services Network, the Synagis® prophylaxis season will begin November 1, 2020, and run through March 31, 2021. Medical Request Forms (MRFs) will be accepted beginning October 15th for initial administration beginning November 1st. Synagis® is available from CenCal Health’s Specialty Pharmacy vendor, Diplomat Specialty Pharmacy. Order forms can be obtained through the CenCal Health website at: www.cencalhealth.org or by contacting Diplomat Specialty Pharmacy directly at (877) 319-6337.
New Pharmacist Services
New Pharmacist Services as a CenCal Health Benefit
CenCal Health will be adding the ability for Pharmacies to bill for specific clinical services rendered by a pharmacist. All added services follow California Assembly Bill 1114, which outlines the specified pharmacist services that are a reimbursable Medi-Cal benefit when rendered to a Medi-Cal Managed care member in the outpatient pharmacy setting. CenCal Health would like to solicit initial interest for provider participation during August and September before implementation of the program.
Please see the initial details for the new program below:
- Eligible Members
- A patient who has active CenCal Health enrollment for the date of service
- Eligible Pharmacists Services
- Eligible Pharmacist Services
- Furnishing travel medications
- Furnishing naloxone hydrochloride
- Furnishing self-administered hormonal contraception
- Initiating and administering immunizations
- Providing tobacco cessation counseling and furnishing nicotine replacement therapy
- Accepted Billing Code
- Evaluation and Management (E&M) billing codes:
- 99201-New patient
- 99212-Established patient
- Administration billing code:
- 90471-Vaccine administration
For further information on the above program, or if you would like to inquire about becoming contracted with CenCal Health to provide the above service, please contact the CenCal Health Pharmacy Department at (805) 562-1080.